The American Board of Board Exams will adapt vignettes to reflect more realistic encounters

The American Board of Board Exams (ABBE) announced on their hypoactive Twitter account that the move will modernize the vignettes to better prepare doctors for real-life encounters, while releasing few ‘revised’ vignettes to the public:

A 59 years old woman with long standing refractory hypertension transfer care to your clinic. Prior to her scheduled appointment you ask her to bring previous documents, test results and her current medications. Upon arrival to your clinic her BP is 161/97, HR 83, RR 20 and temperature is 36.7. She didn’t bring any document to this appointment. She cannot recall the names of her medications. What is the correct medical management of her hypertension?

You are called to cover for a sick colleague in the ICU on Christmas Eve. Late on the afternoon you rush to the bedside of a 79 year old who developed hypotension. His BP is 73/41, and he has had only 3 cc of urine in the last 24 hours. Patient is intubated, on 3 pressors, 4 antibiotics, steroids, TPN, fluids, and is not responsive to any stimuli. Family at bedside argues about advance directives. A maternal cousin with a court order from New York State is a designated guardian for bodily directives. He wishes to continue with intubation and CPR if needed, but not pressors. A paternal half-sister has a court order from Louisiana designating her to be the patient’s guardian for cognition wishes to withdraw ventilation efforts but not the pressor support. No other family members are available. Hospital is unable to summon an ethic committee. Family members speak only in sign language. There is no in-house interpreter. What is the next best step?

A mother is bringing her 17 year old son for evaluation of a rash. The mother says that rash is intermittent, first noticed 3 months ago. Mother reports that the rash is exacerbated on the second Monday and Thursday of each month. On physical exam there is a faint erythematous rash on the left forearm. Exam is otherwise normal including vital signs. Mother shows pictures on her cellphone of the rash when it is “most severe” – you notice an even fainter erythematous rash on forearm. Patient has no complains and wonders why is he in the doctor’s office instead of his basketball practice. What is the most appropriate respond to the mother?

You are seeing a patient with HTN and CKD on HD for the first time. She is febrile but otherwise well. When questioning about her recent fever, you phase out while she intertwine her explanation with an exhausting history of her medical problems and social issues. You feel that it would be unprofessional to ask her to repeat it. What will be your best next action?

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